Sinus hemodynamics after transcatheter aortic valve implantation: Effect of native leaflet length and aortic sinus diameter

Abstract

There are several methods for treating aortic stenosis including transcatheter valve implantation (TAVI) and surgical aortic valve replacement. Among these, TAVI is highly recommended for elderly patients with high surgical risk or a life expectancy of less than 10 yr. However, recent research findings indicate that thrombosis after TAVI leads to the malfunction of TAVI leaflets, which increases the risk of stroke and heart attack. Since the mechanism of thrombus formation is unclear, this study aimed to investigate the sinus hemodynamics after TAVI in different configurations using particle image velocimetry. The results showed that compared with SAV, the TAV resulted in a relatively low velocity at the sinus owing to the native leaflet and skirt of the TAV. The native leaflet length, covering over 75% of TAV, significantly increased the flow stasis and particle residence. In addition, a larger sinus diameter corresponded to a larger stasis area of the same length as that of the native leaflet. According to this study, patients with long native leaflets in their aortic sinus are at a higher risk of developing thrombosis and may require a higher deployment during treatment.